Re: Helping those with mental health conditions » Hello321

There is a lot that you've written here that I quite strongly agree with. I think that you're absolutely right that there are a number of non-pill-based treatment interventions, some of which are evidence based, that people with mental health conditions find helpful when it comes to reducing symptoms, minimizing the impact of symptoms, improving functional outcomes, promoting overall health, or otherwise living as well as possible despite having a mental health condition. Helpful interventions for a mental health condition could include pills (both pharmaceuticals and dietary supplements), talk therapies, psychological self-help interventions, peer support, exercise, dietary modifications, making other choices that promote improved overall health, meditation, brain-training exercises, and support from friends and family members. And this list that I've put together is far from complete. Clearly, not everybody benefits from all of the treatment interventions that I've listed. There is a great deal of variability in how different individuals with mental health conditions respond to each treatment intervention that I identified, and I think that the exact combination of treatment interventions that will be most effective in helping to manage a mental health condition will likely be quite different not only from one individual to the next but also within the same individual as both symptoms and circumstances change.

Speaking for myself, I do take pills, and at this point in time, all of them are dietary supplements. I follow an orthomolecular-based treatment protocol, and I consider this to be the foundation of my treatment. As far as pharmaceuticals are concerned, I consider that to be an approach to treatment that I put a great deal of time and effort into in hopes that one or more medications would contribute positively to my long-term mental well being. Unfortunately, that hasn't seemed to happen, and I've moved on to try other approaches to treatment that do stand at least a chance of improving my long-term mental well being and helping me to achieve my goal of being as close to the person that I'd like to be as possible. As I've said, following an orthomolecular-based approach to reducing the symptoms of my mental health condition is the foundation of my treatment at this point in time. Without this approach, my symptoms are too severe for me to be able to make much use of the benefits of other treatment interventions. In my case, addressing the biological components of my mental health condition as they were identified by testing that was done at an orthomolecular treatment center is absolutely necessary to make any meaningful application of psychological self-help strategies and healthy lifestyle choices possible. But the orthomolecular-based treatment protocol that I follow is still only the foundation of my treatment. It's most certainly not the only aspect of my treatment. I think that when the capacity to take meaningful action toward living a healthy lifestyle, toward applying psychological coping mechanisms and other psychological strategies, and toward achieving some of the bigger goals we have in life is there, we ought to do all of these things to the fullest extent possible. To me, this is what recovering from a mental health condition is all about. Relieving symptoms is a first step, but once there is an adequate amount of symptom relief, applying the knowledge that we've gained about psychology, general health, and other aspects of living and taking action to live our lives in a way that's as consistent as possible with our values and ideals is essential. Pills, if effective, should boost our chances of doing these things, but they're not going to actually do the work for us.

I also think that those of us with mental health conditions have some valid reasons to be dissatisfied with the mental health system and should be taking action to improve it. One thing that journalist Robert Whitaker (2010) pointed out in his book "Anatomy of an Epidemic" that greatly concerns me is that more Americans that ever before seem to be disabled due to a mental health condition, at least judging from the Social Security Administration reports that Whitaker cited in his book. Now, I'm not saying that modern mental health treatments aren't effective for anybody, but the fact that the number of Americans receiving disability benefits for reasons related to mental health is higher than it's ever been, despite the fact that more mental health treatments are available and also more accessible than ever before, calls into question just how effective medications, talk therapies, and other mental health treatments that are commonly used actually are. I tend not to agree with the idea that Whitaker seemed to put forward, which suggests that medication use is generally causing an overall worsening in the outcomes of those living with mental health conditions. In some cases, yes, I do think that medication use is leading to worse outcomes, but there are other factors to consider.

One such factor is the lack of improved of efficacy of the first-line medication treatments that are used for mood disorders today over the first-line medications that were used for the same conditions 40 years ago. Lithium has basically been replaced as a first-line medication treatment for bipolar disorder by anticonvulsants and antipsychotics, even though lithium is still generally regarded as being more effective than antipsychotics and also as effective or more effective than anticonvlusants (Bowden, 2000). Evidence seems to suggest that SSRI antidepressants are about as effective as in the treatment of unipolar depression as tricyclic antidepressants are, although there are some data to suggest that the tricyclics might be more effective in the inpatient treatment of unipolar depression (Anderson, 2000). As far as monoamine oxidase inhibitors are concerned, I'm not sure about the extent to which they've been compared with SSRIs as far as efficacy is concerned, but the fact that moclobemide (a reversible monoamine oxidase A inhibitor) has been found to be somewhat less effective than Nardil and Parnate despite being comparable to the SSRIs as far as efficacy is concerned (Lotufo-Neto et al., 1999) would point toward the possibility that the MAOIs might be more effective than SSRIs. Or at least they might have been more effective, before their formulations were changed. Now, with some anecdotal reports having come in suggesting that the reformulated version of Nardil might be less effective and/or less tolerable for some individuals than the original version was, and with one case report (Malen, 1992) suggesting that the current version of Parnate also might not perform as well as the original version of the medication, it's not even clear if Nardil and Parnate are as effective as they used to be. The U.S. Food and Drug Administration, in my opinion, has not taken the complaints from those who've taken Nardil seriously enough, just as they didn't take the complaints about a generic version of Wellbutrin seriously enough when they first started coming in. Utlimately, though, the FDA did issue statements indicating that some generic versions of Wellbutrin are indeed not therapeutically equivalent to the brand-name version of the medication.

What I'm trying to get at with the information that I'm putting out here is that there are a number of legitimate reasons to be dissatisfied with the mental health system as it exists currently. Although many are helped to a significant degree by the mental health treatments that are currently available, some are not helped by these treatments, and some even experience a deterioration in their condition due to some treatments that are used. When you say things like "we ignore that lives have been ruined by these chemicals," and "[w]e tell ourselves there's no way for these chemicals to cause someone to feel and possibly act homicidal," I'm not sure who you're referring to when you say "we," because I acknowledge that psychiatric medications have affected some individuals who've taken them in detrimental ways, including by contributing to increased homicidal thinking and actions in what's probably a small minority of cases. But I think that you're right that the detrimental effects of psychiatric medications and all treatments used in medicine shouldn't be ignored.

Where I think you're wrong is in your statement that "[t]here is no science behind any idea that an antidepressant corrects any dysfunction in the brain." Monoamine oxidase A levels have been found to be, on average, 34 percent higher in the brains of patients with major depressive disorder in comparison to the brains of healthy control participants (Meyer et al., 2006). Monoamine oxidase inhibiting antidepressants have clearly demonstrated an ability to inhibit the MAO-A enzyme, so to state that there is no science behind the idea that any antidepressant can "correct" any chemical dysfunction in the brain is inaccurate. Just because many who identify as being part of the anti-psychiatry movement say that something is true doesn't mean that it is. Those who consider themselves to be part of the anti-psychiatry movement sometimes make some valid critiques of psychiatry, and I think that those critiques ought to be taken seriously and ought to lead to change wherever they can. However, if many with ideas that might be considered to be critical of psychiatry continue to say that mental health conditions are never in any way biological, that psychiatric medications are never beneficial to those who take them, that mental illness doesn't exist, or that other blatant inaccuracies ought to be regarded as true, they're only going to hurt the credibility of those who make critiques of psychiatry that actually are valid.

Anderson, I.M. (2000). Selective serotonin reuptake inhibitors versus tricyclic antidepressants: A meta-analysis of efficacy and tolerability. Journal of Affective Disorders, 58, 19-36. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10760555

Bowden, C.L. (2000). Efficacy of lithium in mania and maintenance therapy of bipolar disorder. Journal of Clinical Psychiatry, 61 Suppl 9, 35-40. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10826659

Lotufo-Neto, F., Trivedi, M., & Thase, M.E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidase type a moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-247. Article: http://www.nature.com/npp/journal/v20/n3/full/1395258a.html

Meyer, J.H., Ginovart, N., Boovariwala, A., Sagrati, S., Hussey, D., Garcia, A., et al. (2006). Elevated monoamine oxidase a levels in the brain: An explanation for the monoamine imbalance of major depression. Archives of General Psychiatry, 63, 1209-1216. Article: http://archpsyc.jamanetwork.com/article.aspx?articleid=668227

Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Broadway Paperbacks.

"Maybe someday
We'll figure all this out
We'll put an end to all our doubt
Try to find a way to just feel better now"

- Rob Thomas

Re: Helping those with mental health conditions » Hello321

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